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Like in the previous game of the Punch-Out!! series, the player assumes the role of a green-haired boxer, known only by three initials. The player assumes the role of a boxer working through the ranks of the World Video Boxing Association (WVBA). During matches, the player's boxer is viewed from behind as a wireframe so that the opponents can be seen. The player must time his punches, dodges, and blocks in order to defeat the opposing boxer. Hints are given as to the opponent's next move by subtle eye changes, such as the white of the eyes turning from white to yellow, but the player must ultimately predict what moves the opponent will make and react appropriately.

Once the player defeats the final opponent, the opponents repeat, while the player will win the Heavyweight Belt, then defend it against the same characters that he has beaten. On each successive round, the opponents are harder and quicker. For each opponent, the player must knock them out within three minutes; three knockdowns guarantees a TKO. After the player's second loss, the winning opponent comes forward and taunts the player.

The game is housed in a modified upright cabinet. Like the last game, it requires two monitors, one atop the other, for the game's display. The top monitor is used to display statistics while the bottom one is the main game display. Apart from this, the game is more or less a standard upright. The game has a joystick and three buttons. Two buttons control left and right punches, one for each arm. One button delivers an uppercut or knockout blow. Unlike the original Punch-Out!!, Super-Punch-Out!! also featured a joystick which could be pulled straight up (almost as if you were trying to yank the joystick out of the machine). Doing so caused your green-haired character to duck, which was crucial in beating certain opponents.

Like in the previous installment, Mario, Luigi, Donkey Kong, and Donkey Kong Junior all appear in the audience. Also, one of the victory tunes heard in the Super Punch-Out!! arcade was also used in Nintendo's Baseball for the NES as the home run tune.

An unlicensed version called "Frank Bruno's Boxing" for the Commodore 64, change the names of three fighters. Dragon Chan became Sling Long-Chop, Bear Hugger became The Canadian Crusher and Vodka Drunkenski became Andre Punchetenov

This game inspired the development and release of Super Punch-Out!! for the Super Nintendo Entertainment System in 1994. Several elements, such as opponents, were changed for this version. Characters from both Punch-Out!! arcade games were featured in the game with basically the same looks and attacks. The gameplay is mostly similar to both Punch-Out!! arcade games as well, though with some new features.